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House Democrats Rally Around Health Care Package

By Drew Armstrong and Edward Epstein, CQ Staff

October 29, 2009 -- House Democratic leaders on Thursday introduced their long-awaited health care overhaul package, as rank-and-file party members appeared to be rallying behind the proposal.

The nearly 2,000-page bill (HR 3962) is expected to be on the House floor late next week.

Senate Democrats are lagging their House counterparts. Senate Majority Leader Harry Reid, D-Nev., who is working to draft a final bill in that chamber, will not be ready to introduce one this week, his spokesman said Thursday.

The House bill contains a public insurance option that would have the government negotiate rates with health care providers, along with a mandate that individuals obtain coverage and that businesses offer it. It would be financed in part by a surtax on the wealthiest Americans.

The legislation does not include a proposal to repeal a Medicare payment formula that sets doctors' payment rates. The formula has demanded deep cuts in recent years, as well as far into the future. That issue will be addressed in a separate bill that would do away with the formula and the required cuts, and would split up Medicare's payments to doctors into different categories, such as preventive care. Each category would then be subject to its own cost-control formula.

Early indications were that House Democrats across the ideological spectrum were lining up behind the main health care measure, which was assembled by Speaker Nancy Pelosi, D-Calif., and her team.

Republicans, as expected, uniformly denounced the legislation. Not a single GOP member is expected to vote for it.

"How are we going to fix our health care with 1,990 pages of bureaucracy?" Minority Leader John A. Boehner, R-Ohio, asked at a press conference.

Boehner wouldn't say if the minority will offer an alternative bill once the measure reaches the floor, but he said Republicans are working on several alternatives.

Winning Over Doubters
At a morning House Democratic Caucus session, Jim McGovern, D-Mass., said that Earl Pomeroy, D-N.D., a centrist who had been wary of a "robust" public option that would link provider payments to Medicare rates, rose to say he would now support the bill. McGovern said members greeted that news with a standing ovation.

Pomeroy said he had begun moving toward supporting the bill after an Oct. 26 meeting with Pelosi, where he "had the sense" that she would agree to a public option that allows health providers to negotiate their rates, instead of paying them rates based on Medicare. That was Pomeroy's "bright-line issue," he said; he thinks Medicare does not pay doctors and hospitals in his district well enough. Other moderates felt similarly, he said.

"This bill will pass the House," he said.

Gerald E. Connolly, D-Va., president of the freshman class, who had withheld support up to now, said, "I look forward to supporting the bill."

Connolly emphasized the bill's projected help in controlling health care costs and premiums for small businesses. "Small-business owners across the nation need this kind of legislation, and they need it now," he said.

And among liberals who had pushed for a public option linked to Medicare payment rates, there was also support, even though the bill does not adopt their preferred approach for a government-run plan.

"Our people in this country need health care reform," said Mary Jo Kilroy, D-Ohio. "I prefer the plan that costs less and covers more people, but we need to get a bill done."

Pelosi led Democrats down the West Front steps of the Capitol to unveil her bill after the caucus held its morning meeting. The event had the feel of a political convention, with rock music piping out of big speakers and a half-dozen aides carrying narrow signs atop 12-foot poles that extolled the virtues of the proposal.

The Speaker likened the bill's introduction to major progressive achievements of the past.

"It is with great pride and humility that we come before you to follow in the footsteps of those who gave our country Social Security, and then Medicare, and now universal affordable health care," Pelosi told the assembled crowd.

Democratic leaders have struggled for weeks to produce a final bill from the varying versions of legislation (HR 3200) approved earlier by three House committees: Ways and Means, Education and Labor, and Energy and Commerce. Much of their negotiations focused on how to craft a government-run health insurance option to compete with private insurers on state-run "exchanges," or marketplaces, where individuals and small businesses could purchase health coverage.

The option they settled on—in which the government would negotiate rates with health care providers like doctors and hospitals—is a step back from the Medicare-based plan House progressives fought for.

President Obama has invited the liberal groups within the House Democratic Caucus to the White House this afternoon to urge support for the final bill.

Cost Estimates
The Congressional Budget Office on Thursday estimated the bill's net cost at $894 billion over 10 years, and said it reduces the deficit by $104 billion over 10, with further slight reductions thereafter. It would cover 96 percent of the eligible population, up from 83 percent now, according to CBO.

The estimate also says public plan premiums would probably be higher than private plans, on average, because the public plan would do less to limit utilization of health services and would attract a sicker pool of customers.

The legislation would be paid for largely by a surtax on the adjusted gross income of individuals making more than $500,000 and married couples making more than $1 million. Those thresholds are higher than in the previous version of the bill, and thus likely to yield less revenue.

The bill contains new revenue-raisers that would impose tax-compliance requirements on businesses and create a 2.5 percent excise tax on certain medical devices.

The revenue provisions are likely to be a significant point of contention between the House and the Senate, which is heading toward using an excise tax on high-cost health insurance plans as its main tax funding stream.

Some Protest
At the ceremony to introduce the bill, protesters gathered on the lawn to rally against the bill.

One, equipped with a bullhorn and standing about 100 feet away, shouted that Pelosi and her allies would "burn in hell for this."

"Thank you, insurance companies of America," Pelosi responded, to laughter.

The protesters appeared to be largely anti-abortion activists. Police confiscated the bullhorn, which was suddenly silenced after a burst of feedback. A woman among the protesters began shouting in place of the bullhorn, but could not be heard over Pelosi's remarks.

Conservatives had sought to add explicit language to the legislation that would prevent any funding under the bill from going to support abortion. Senior Democrats say that the bill would do nothing to expand funding for abortion and does not require an explicit ban.

Alan K. Ota, Alex Wayne and Kathleen Hunter contributed to this story.

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